Causal relationship between basal metabolic rate and kidney function: a bidirectional two-sample mendelian randomization study.

Background: The relationship between basal metabolic rate (BMR) and Chronic kidney disease (CKD) remains unclear and controversial. In this study, we investigated the causal role of BMR in renal injury, and inversely, whether altered renal function causes changes in BMR. Methods: In this two-sample mendelian randomization (MR) study, Genetic data were accessed from published genome-wide association studies (GWAS) for BMR ((n = 454,874) and indices of renal function, i.e. estimated glomerular filtration rate (eGFR) based on creatinine (n =1, 004, 040), CKD (n=480, 698), and blood urea nitrogen (BUN) (n =852, 678) in European. The inverse variance weighted (IVW) random-effects MR method serves as the main analysis, accompanied by several sensitivity MR analyses. We also performed a reverse MR to explore the causal effects of the above indices of renal function on the BMR. Results: We found that genetically predicted BMR was negatively related to eGFR, (ß= -0.032, P = 4.95*10-12). Similar results were obtained using the MR-Egger (ß= -0.040, P = 0.002), weighted median (ß= -0.04, P= 5.35×10-11) and weighted mode method (ß= -0.05, P=9.92×10-7). Higher BMR had a causal effect on an increased risk of CKD (OR =1.36, 95% CI = 1.11-1.66, P =0.003). In reverse MR, lower eGFR was related to higher BMR (ß= -0.64, P = 2.32×10-6, IVW analysis). Bidirectional MR supports no causal association was observed between BMR and BUN. Sensitivity analyses confirmed these findings, indicating the robustness of the results. Conclusion: Genetically predicted high BMR is associated with impaired kidney function. Conversely, genetically predicted decreased eGFR is associated with higher BMR.

Associations of sarcopenic obesity vs either sarcopenia or obesity alone with cognitive impairment risk in patients requiring maintenance hemodialysis.

BACKGROUND: The association between sarcopenic obesity (SO) and cognitive impairment (CI) risk in patients requiring maintenance hemodialysis (MHD) is not known. In this study, we investigated the prevalence of SO in MHD patients. Furthermore, we would explore and compare the associations between SO, sarcopenia, and obesity with CI risk in this population. METHODS: A multicenter, cross-sectional study was conducted. Data from 2743 adult MHD patients were recorded. SO was defined as the co-occurrence of sarcopenia and obesity. Cognitive function was assessed with the Mini-Mental State Examination (MMSE). Multiple logistic regression models, stratified analyses, and interactive analyses were conducted. RESULTS: 21.58% of the participants met the criteria for SO. The overall prevalence of CI was 23.3% in our study. Participants in the SO group had the highest CI prevalence (34.6%). The association between SO and CI was weakened but remained statistically significant after adjusting for age, sex, and educational status (odds ratio, 1.47; 95% CI, 1.11-1.96). However, associations between sarcopenia, obesity, and CI disappeared after adjusting for these variables. The additional adjustment did not attenuate the significant association between SO and CI. Subgroup analyses and interactive analyses showed that the associations were similar across subgroups (P > 0.05 for interaction for all). CONCLUSIONS: SO and CI are highly prevalent in MHD patients. Participants with SO are at significantly higher risk of CI than those with sarcopenia or obesity alone. Furthermore, this association is consistent across different subgroups.

A Higher Whole-Body Extracellular to Intracellular Water Ratio Is Associated with Increased Odds of Cognitive Impairment in Hemodialysis Patients.

BACKGROUND: Cognitive impairment (CI) is highly prevalent in patients undergoing hemodialysis. Whether fluid overload with malnutrition as assessed by the ratio of extracellular water to intracellular water (ECW/ICW) is associated with CI in patients on maintenance hemodialysis (MHD) has yet to be studied. OBJECTIVE: This study aimed to investigate the association between ECW/ICW and CI in patients with MHD. METHODS: We conducted a multicenter, cross-sectional study that enrolled 3,025 adult patients with MHD. Cognitive function was assessed through the Mini-Mental State Examination. The ECW/ICW was derived from a portable body composition monitor and analyzed by quartiles. RESULTS: 23.04% of participants had CI in our study. The prevalence of CI tended to increase as the quartiles of the ECW/ICW ratio increased. Unadjusted analysis showed that participants in quartile 4 were 3.02 times more likely to have a CI compared to those in quartile 1. After adjusting for age, sex, education, smoking status, body mass index, dialysis vintage, history of hypertension, and history of stroke, the adjusted OR (95% CI) for the highest quartile of ECW/ICW ratio was 1.36 (1.01, 1.83) for CI compared with the lowest quartile. Interestingly, the association between ECW/ICW ratio and CI persisted across all subgroups stratified by age, gender, history of diabetes, and stroke. (p for interaction > 0.05 for all). CONCLUSION: An increased ECW/ICW ratio is associated with higher odds of cognitive impairment in patients undergoing hemodialysis.

Increased Predialysis Extracellular to Intracellular Water Ratio Is Associated With Sarcopenia in Hemodialysis Patients.

OBJECTIVE: To explore the association between fluid overload, evaluated by a new fluid overload indicator, the bioelectrical impedance analysis-derived whole-body extracellular to intracellular water ratio (ECW/ICW), and sarcopenia in maintenance hemodialysis (MHD) patients. METHODS: A multicenter, cross-sectional study that included 3320 adult MHD patients was conducted in 20 hemodialysis centers of Guizhou Province, Southwest China from June 1, 2020, to September 30, 2020. The diagnosis of sarcopenia was based on the Asian Working Group's definition of sarcopenia. Multiple logistic regression models, stratified analyses, and interactive analyses were conducted. RESULTS: A total of 3196 participants were included in the final analysis. The prevalence of sarcopenia was 36.2% in the total population. The prevalence of sarcopenia was increased with increasing quartiles of ECW/ICW (18.1%, 33.3%, 37.8%, and 55.4% for the first, second, third, and fourth quartiles, respectively). Increased ECW/ICW was significantly associated with sarcopenia. The association remained statistically significant even after adjusting for age, sex, body mass index (BMI), dialysis vintage, C-reactive protein, and various medical histories. The odds ratios were 2.11 (1.41, 3.14), 1.83 (1.22, 2.76), and 3.45 (2.21, 5.39) for ECW/ICW quartiles 2-4, respectively (P for trend <.001). The interaction analysis showed that history of diabetes had an interactive role in the association between ECW/ICW and sarcopenia (P for interaction = .034). The association stably existed across subgroups and was more prominent in older patients and those with higher BMI and a history of diabetes. CONCLUSIONS: Elevated ECW/ICW was associated with increased sarcopenia risk independent of BMI, prealbumin, C-reactive protein, and other potential confounders in MHD patients. The association was more prominent in older patients and those with higher BMI and a history of diabetes, suggesting that controlling volume balance may help to reduce the occurrence of sarcopenia in these populations.

Increased extracellular water/body mass is associated with functional impairment in hemodialysis patients.

BACKGROUND: Functional impairment, malnutrition and fluid overload are prevalent in patients undergoing maintenance hemodialysis (MHD). The extracellular water/body cell mass ratio (ECW/BCM) is a new indicator reflecting fluid overload and malnutrition. A previous study has suggested that it performs better than other indices in assessing fluid status. This study investigates the relationship between pre-dialysis whole-body ECW/BCM and physical function in MHD patients. METHODS: We conducted a multicenter, cross-sectional study in Guizhou Province in Southwest China. The Karnofsky Performance Status (KPS) was used to evaluate patients' functional status. Patients with KPS scores of ≤ 80 were considered to have a functional impairment. The body composition was measured using the body composition monitor (BCM), and the value of the ECW/BCM ratio was calculated. The subjects were classified into three groups according to ECW/BCM tertiles. Multiple logistic regression models and interactive analyses were conducted. RESULTS: The final analysis included 2818 subjects. Multivariate logistic regression analyses showed that compared with the lowest tertile (tertile 1), the adjusted odds ratio of functional impairment were 1.95 (95% CI: 1.21-3.13, p < 0.001) and 2.10 (95% CI: 1.31-3.37, p < 0.001) in the second and the third tertiles of ECW/BCM, respectively after adjusting for age, sex, current smoking status, history of stroke, heart failure, diabetes, and myocardial infarction. Subgroup analysis showed that the association existed stably across all subgroups stratified by age, gender, cognitive impairment (CI), history of stroke, heart failure, and diabetes (all p values for interaction >0.05). CONCLUSIONS: Elevated ECW/BCM is independently linked to an increased risk of functional impairment in patients with MHD.

Single-cell RNA sequencing data analysis suggests the cell-cell interaction patterns of the pituitary-kidney axis.

Kidney functions, including electrolyte and water reabsorption and secretion, could be influenced by circulating hormones. The pituitary gland produces a variety of hormones and cytokines; however, the influence of these factors on the kidney has not been well explained and explored. To provide more in-depth information and insights to support the pituitary-kidney axis connection, we used mouse pituitary and kidney single-cell transcriptomics data from the GEO database for further analysis. Based on a ligand-receptor pair analysis, cell-cell interaction patterns between the pituitary and kidney cell types were described. Key ligand-receptor pairs, such as GH-GHR, PTN-SDC2, PTN-SDC4, and DLK1-NOTCH3, were relatively active in the pituitary-kidney axis. These ligand-receptor pairs mainly target proximal tubule cells, principal cells, the loop of Henle, intercalated cells, pericytes, mesangial cells, and fibroblasts, and these cells are related to physiological processes, such as substance reabsorption, angiogenesis, and tissue repair. Our results suggested that the pituitary gland might directly regulate kidney function by secreting multiple hormones or cytokines and indicated that the above ligand-receptor pairs might represent a new research focus for studies on kidney function or kidney disease.

Muscle strength performed better than muscle mass in identifying cognitive impairment risk in maintenance hemodialysis patients.

OBJECTIVES: The association between muscle mass and cognitive impairment (CI) is conflicting. We aimed to evaluate and compare the associations of muscle strength, muscle mass and CI risk in maintenance hemodialysis (MHD) patients. METHODS: We conducted a multicenter, cross-sectional study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) score. Muscle strength was assessed by hand grip strength (HGS), muscle mass was assessed by lean tissue mass (LTM). Education status was divided into two groups: lower education status (senior middle school and below) and higher education status (high school and above). Multivariable logistic regression models and subgroup analyses were performed. Receiver-operating characteristic (ROC) analyses were conducted to compare their predictive power in discriminating CI. RESULTS: 2827 adult MHD patients were included in our final analysis. Patients in the lowest quartile of HGS was 2.82-fold as likely to have CI as compared to those in the highest quartile, while participants in the lowest quartile of LTM group were 1.52-fold as likely to have CI, when compared with the highest quartile group of LTM after adjusting for age, gender and education level. The association persisted in all subgroups except for women and well-educated participants. There was a significant interaction between HGS and education status on CI and age played an interactive role in the association between LTM and incident CI (P for interaction < 0.05). The AUC value of the HGS was significantly higher than that of LTM (0.69 VS 0.63, P < 0.001). CONCLUSIONS: Muscle strength performed better than muscle mass in identifying individuals at high risk of CI, particularly in male and less educated Chinese MHD patients. LEVEL OF EVIDENCE: Level V, cross-sectional study.

Study on Correlation between Body Cell Mass Index and Cognitive Impairment in Hemodialysis Maintaining Patients: A Cross-Sectional Study.

Objective: To investigate the relationship between body cell mass index (BCMI) and cognitive impairment in maintaining hemodialysis (MHD) patients. Methods: We collected the general materials, laboratory indexes, and physical measurement indexes of patients undergoing maintenance hemodialysis in hemodialysis centers of 20 tertiary and tertiary general hospitals in Guizhou Province from June to September 2020. The body composition was measured by bioelectrical impedance method, and the BCMI value was calculated. The subjects were divided into normal cognitive function group (score ≥27), mild cognitive impairment group (score 23-26), and severe cognitive impairment group (score <23). Two groups of people with normal cognitive function and cognitive impairment with similar baseline data (gender, age, and education) were obtained by propensity score matching (PSM). Results: A total of 2008 subjects were included in this study, including 467 cases (23.3%) in the cognitive impairment group. A total of 814 cases were accurately matched after PSM. Multivariate logistic regression analysis showed that the incidence risk of the BCMI Q1 group was 8.99 times higher than that of the Q4 group (95% CI: 5.74 ∼ 14.09, P < 0.001). ROC curve analysis showed that the best threshold of BCMI for predicting cognitive impairment in MHD patients was 9.05, the sensitivity and specificity were 71.5% and 62.7%, respectively, and the area under the curve was 0.713 (95% CI: 0.678 ∼ 0.748, P < 0.001). Conclusions: BCMI is related to cognitive impairment in MHD patients and has predictive value for the onset of cognitive impairment in MHD patients.

Comparison of novel visceral obesity indexes with traditional obesity measurements in predicting of metabolically unhealthy nonobese phenotype in hemodialysis patients.

BACKGROUND: Normal-weight maintenance hemodialysis (MHD) patients with abdominal obesity exhibited a more proatherogenic profile than overweight and obesity patients with abdominal obesity, highlighting the importance of early identification of metabolically unhealthy nonobese (MUNO) in this population. Visceral fat accumulation plays a crucial role in the development of MUNO. Lipid accumulation product (LAP), visceral adiposity index (VAI) have been proved as reliable visceral obesity markers. The Chinese visceral adiposity index (CVAI) and a body shape index (ABSI) are newly discovered indexes of visceral obesity and have been reported to be associated with multiple metabolic disorders. There are limited studies investigating the associations between different visceral obesity indices and risk of MUNO, especially in hemodialysis patients. Moreover, no general agreement has been reached to date regarding which of these obesity indices performs best in identifying MUNO. We aimed to investigate the prevalence of MUNO in MHD patients and compare the associations between different adiposity indices (CVAI, ABSI,VAI, LAP, body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHtR)) with MUNO risk in this population. METHODS: We conducted a multi-center cross-sectional study in Guizhou Province, Southwest China. 1302 nonobese adult MHD patients were included in our study. MUNO was defined as being nonobese and having the presence of > = 2 components of metabolic syndrome (MetS). Nonobese was defined as BMI less than 25 kg/m2. VAI, LAP, CVAI, ABSI, BMI, WC and WHtR were calculated. Logistic regression analyses and receiver operator curve (ROC) analyses were performed. Results 65.6% participants were metabolically unhealthy. The ROC curve analysis demonstrated that of the seven obesity indices tested, the VAI (AUC 0.84 for women and 0.79 for men) followed by LAP (AUC 0.78 for women and 0.72 for men) had the highest diagnostic accuracy for MUNO phenotype while ABSI exhibited the lowest AUC value for identifying MUNO phenotype CONCLUSIONS: Metabolically unhealthy is highly prevalent in nonobese MHD patients. VAI and LAP outperformed CVAI in discriminating MUNO in MHD patients. Though ABSI could be a weak predictor of MUNO, it is not better than WHtR, WC and BMI.

Successful treatment with plasma exchange followed by intravenous immunoglobulin in a critically ill patient with COVID-19.

Here we report a case of a laboratory-confirmed 2019 novel coronavirus (2019-nCoV)-infected patient with COVID-19 (coronavirus disease 2019) who developed respiratory failure and shock accompanied by persistent diarrhoea despite conventional therapeutic interventions. The patient avoided mechanical ventilation and showed an immediate clinical and radiological improvement following treatment with intensive plasma exchange (PE) followed by intravenous immunoglobulin (IVIG). Successful therapeutic strategies in this case suggest that timely initiation of PE treatment followed by IVIG in critically ill patients with COVID-19 may prevent the disease from worsening and help to reduce the requirement for mechanical ventilation and intensive supportive care. Moreover, it may improve poor clinical outcomes of these patients.

Comparison of visceral, general and central obesity indices in the prediction of metabolic syndrome in maintenance hemodialysis patients.

PURPOSE: We aimed to compare the predictive ability of the anthropometric indices reflecting general, central and visceral obesity for identification of metabolic syndrome (MetS) in maintenance hemodialysis (MHD) patients. METHODS: A multicenter, cross-sectional study that consisted of 1603 adult MHD patients (54.6 ± 16 years) was conducted in Guizhou Province, Southwest China. Eight anthropometric obesity indexes including body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), conicity index (Ci) and visceral adiposity index (VAI), lipid accumulation product (LAP), a body shape index (ABSI) and body roundness index (BRI) were recorded. MetS was defined based on the criteria of the International Diabetes Federation. Participants were categorized into four groups according to quartiles of different obesity indices. Binary logistic regression analyses were used to evaluate the associations between the eight obesity parameters and MetS. Receiver operator curve (ROC) analyses were used to identify the best predictor of MetS. RESULTS: The eight anthropometric obesity indexes were independently associated with MetS risk, even after adjustment for age, sex, educational status and history of smoking. The ROC analysis revealed that all the eight obesity indices included in the study were able to discriminate MetS [all area under the ROC curves (AUCs) > 0.6, P < 0.05]. LAP showed the highest AUC and according to the maximum Youden indexes, the cut off values for men and women were 27.29 and 36.45, respectively. The AUCs of LAP, VAI, ABSI, BRI, WC, WHtR, Ci and BMI were 0.88, 0.87, 0.60, 0.78, 0.79, 0.78, 0.69 and 0.76 for men, and 0.87, 0.85, 0.65, 0.79, 0.81, 0.79, 0.73 and 0.76 for women, respectively. There was no significant difference in the AUC value between LAP and VAI, BRI/WHtR and BMI in men and between BRI/WHtR and BMI in women. The AUC value for WHtR was equal to that for BRI in identifying MetS. CONCLUSIONS: Visceral obesity marker LAP followed by VAI was the most effective predictor of MetS while ABSI followed by CI was the weakest indicator for the screening of MetS in MHD patients. BRI could be an alternative obesity measure to WHtR in assessment of MetS. LAP may be a simple and useful screening tool to identify individuals at high risk of MetS particularly in middle-aged and elderly Chinese MHD patients. LEVEL OF EVIDENCE: Level V, descriptive study.

Visceral, general, abdominal adiposity and atherogenic index of plasma in relatively lean hemodialysis patients.

BACKGROUND: Obesity is a well-established risk factor for atherosclerosis. However, it is unknown which measure of adiposity best relates to atherosclerosis in relatively lean maintenance hemodialysis (MHD) patients. We aimed to explore and compare the associations between different adiposity indices reflecting general, abdominal, visceral adiposity and arteriosclerosis risk with atherogenic index of plasma(AIP) in relatively lean MHD patients. METHODS: We conducted a multicenter, cross-sectional study in Guizhou Province, Southwest China. General/abdominal adiposity indices like body mass index (BMI), waist circumference(WC), waist-height ratio(WHtR), conicity index (Ci) and visceral obesity indices including visceral adiposity index (VAI), lipid accumulation product (LAP) and the hypertriglyceridemic waist phenotype (HW phenotype) were recorded. Univariate and multivariate linear regression models were used. RESULTS: All adiposity indices correlated positively with AIP in univariate analysis both in men and women except for Ci. After adjustment for age and traditional atherosclerosis risk factors, BMI, WC, WHtR, VAI and LAP still had associations with AIP both in men (ß = 0.265, 0.153, 0.16, 0.788 and 0.74, respectively, all P < 0.001) and women (ß = 0.34,0.199, 0.21, 0.83 and 0.74, respectively, all P < 0.001). After further adjustment for BMI, associations between AIP and VAI, LAP remained significant, but associations between WC, WHtR and AIP disappeared. CONCLUSIONS: The HW phenotype, VAI, and LAP, validated and convenient markers of visceral obesity, were superior to classical anthropometric general/ abdominal adiposity indices for atherosclerosis risk assessment, especially in relatively lean MHD patients aged 40 years or older.

Identification of chronic kidney disease risk in relatively lean Southern Chinese: the hypertriglyceridemic waist phenotype vs. anthropometric indexes.

PURPOSE: Assessing and comparing the ability of the hypertriglyceridemic waist (HW) phenotype and anthropometric obesity indexes to identify subjects at high risk of chronic kidney disease (CKD) in a relatively lean population in South China. METHODS: Using data from a community-based, cross-sectional study conducted in Zhuhai City, Southern China, we examined associations between the HW phenotype, anthropometric obesity indexes, and incident CKD risk in a relatively lean population. Multiple logistic regression analyses were used to evaluate the associations. RESULTS: The HW phenotype associated with CKD significantly in the unadjusted analysis (OR 3.53, 95% CI 1.65-7.52, P = 0.001). Further adjustment for gender, age, and other potential confounding variables had an impact on the odd ratios (OR); the OR decreased but still existed (OR 2.91, 95% 1.23-6.87, P = 0.016). The association of the HW phenotype with CKD remained significant after further adjustment for hypertension and diabetes. No significant association between the anthropometric indexes and incident CKD was found. CONCLUSION: The HW phenotype, but not the anthropometric indexes, is associated with an elevated risk of CKD in relatively lean subjects. The HW phenotype appears to be a better predictor of CKD than the anthropometric indexes. LEVEL OF EVIDENCE: Level V, descriptive study.

Correlation of visceral adiposity index with chronic kidney disease in the People's Republic of China: to rediscover the new clinical potential of an old indicator for visceral obesity.

AIM: To validate the association between visceral obesity and pathogenesis of chronic kidney disease (CKD) among individuals aged 40 years and above, and the potential of visceral adiposity index (VAI) to predict CKD. METHODS: This study was based on a cross-sectional epidemiologic study in the People's Republic of China. A total of 1,581 residents aged over 40 years were included and divided into four groups based on VAI quartile intervals, namely, Groups I, II, III, and IV (eg, Group I included patients with their VAIs in the lowest quartile). Logistic regression analysis was performed. RESULTS: VAI is positively correlated with the albumin-to-creatinine ratio and the prevalence of CKD (P<0.001), and is inversely related to estimated glomerular filtration rate (P<0.001). Using Group I as control, odds ratios (ORs) were calculated to quantify the risk of developing CKD as VAI increased (Group II 1.08 [P>0.05], Group III 1.57 [P<0.05], Group IV 2.31 [P<0.001]). Related factors like age and sex were normalized in the logistic model before calculation. ORs became 1.16 (P>0.05), 1.59 (P<0.05), and 2.14 (P<0.05), respectively, for each group after further normalization considering smoking, drinking, physical activity, education, and the history of hypertension, coronary heart disease, and diabetes. The same results were not observed after fasting blood glucose and blood pressure levels were included in the normalization. There was no significant difference in the ORs for different groups: 0.94 (P>0.05), 1.11 (P<0.05), and 1.68 (P>0.05), respectively. CONCLUSION: VAI is highly correlated with the prevalence of CKD in the population aged 40 years and above. It can be used to predict the pathogenesis of CKD, which is dependent on fasting blood glucose and blood pressure levels.

Visceral adiposity index, hypertriglyceridemic waist phenotype and chronic kidney disease in a southern Chinese population: a cross-sectional study.

OBJECTIVE: To explore the relationships between visceral adiposity index (VAI), hypertriglyceridemic waist phenotype (HW phenotype) and chronic kidney disease (CKD). METHODS: A cross-sectional study was conducted in Zhuhai City June-October 2012. A total of 2142 participants were recruited. Logistic regression was used to evaluate the associations between VAI, HW phenotype and CKD. RESULTS: After adjustment for age, VAI was significantly associated with CKD (OR 2.16, 95 % CI 1.25-3.74, P = 0.006) in women. Further adjusted for potential confounders, the association was still significant in women (OR 2.07, 95 % CI 1.17-3.64, P = 0.01). However, the association was abolished when adding diabetes and hypertension to the model (OR 1.68, 95 % CI 0.92-3.06, P = 0.09). The age-adjusted OR (95 % CI, P) of CKD associated with HW phenotype was 2.21 (1.29-3.76, 0.004) and 2.54 (1.53-4.22, <0.001) for men and women, respectively. Further adjusted for potential confounders, the associations were still significant in both subgroups. The OR for CKD was 2.41 (95 % CI 1.42-4.12, P = 0.001) and 2.32 (95 % CI 1.31-4.11, P = 0.004) for women and men, respectively. When further adjusted for diabetes and hypertension, the association of HW phenotype and CKD was significant (OR 1.88, 95 % CI 1.05-3.36, P = 0.033) in women. However, the model is abolished in men (OR 1.50, 95 % CI 0.81-2.78, P = 0.19). CONCLUSION: Our results suggest that both VAI and the HW phenotype might be useful clinical indicators of CKD in China for females but not for males. The HW phenotype associated more strongly with CKD, compared with VAI.

[Detection of PLA2R1 in renal biopsy specimens of patients with idiopathic membranous nephropathy].

OBJECTIVE: To investigate the prevalence of PLA2R1 in renal biopsy specimens of patients with idiopathic membranous nephropathy (IMN) and explore the relationship between PLA2R1 and IMN. METHODS: A total of 108 adult patients with biopsy-proved glomerular diseases were enrolled in this study, including 41 with IMN, 2 with hepatitis B-associated membranous nephropathy, 8 with V lupus nephritis, 27 with IgA nephropathy, 19 with minimal change nephropathy, 5 with mild mesangial proliferative glomerulonephritis, and 6 with focal segmental glomeruloselerosis (FSGS). Indirect immunofluorescence assay was used to detect PLA2R1 in the biopsy specimens and the clinical variables of the IMN patients were analyzed. RESULTS: In 35 of the 41 (85.37%) patients with IMN, PLA2R1 was detected with a fine granular pattern in the subepithelial deposits along the glomerular capillary loops. PLA2R1 antigen was not detected in patients with other glomerulopathies. No significant differences were found in age, serum creatinine, serum albumin, or 24-h urinary protein level between PLA2R1-positive and negative patients with IMN (P>0.05). CONCLUSION: According to our results, 85.37% of adult patients with biopsy-proven IMN are positive for PLA2R1 antigen, which, however, does not contribute to variations of the patients' clinical manifestations.

[Detection of serum food specific antibodies of 6 common foods in patients with IgA nephropathy].

OBJECTIVE: To explore the relationship between the major allergens of 6 common allergic foods and IgA nephropathy. METHODS: A sensitive sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of food-specific IgA1, IgG and IgE in 31 patients with IgA nephropathy and 80 healthy volunteers. All the patients were examined for a history of food allergy using a questionnaire. RESULTS: Serum levels of IgA1 and IgG against the major allergens of the 6 common allergic foods were significantly higher in patients with IgA nephropathy than in healthy volunteers (P<0.05). There was no detectable food-specific IgE antibodies in the two groups. No patients had a clear history of food allergy. All the patients with increased IgG levels specific to 4 or more foods simultaneously had proteinuria. CONCLUSIONS: Some foods especially the highly allergic ones may participate in the pathogenesis and progression of IgA nephropathy.

Hypertriglyceridemic waist phenotype and chronic kidney disease in a Chinese population aged 40 years and older.

OBJECTIVE: To examine the relationship between the HW phenotype and risk for CKD in a community population aged 40 years and older. METHODS: A cross-sectional study was conducted in Zhuhai from June to October 2012. The participants were divided into three groups: Group 1, Waist circumference >90 cm in men or >85 cm in women and triglycerides ≥2 mmol/l; Group 3, Waist circumference ≤90 cm in men or ≤85 cm in women and triglycerides <2 mmol/l; Group 2, The remaining participants. The prevalence of the three subgroups and CKD were determined. The association between HW phenotype and CKD was then analyzed using SPSS (version 13.0). RESULTS: After adjusting for age and sex, Group 1 was associated with CKD (OR 3.08, 95% CI 2.01, 4.73, P<0.001), when compared with Group 3. Further adjustment for factors which were potential confounders and unlikely to be in the causal pathway between the HW phenotype and CKD, Group 1 was still significantly associated with CKD. The OR for CKD was 2.65 (95% CI 1.65, 4.26, P<0.001). When adjusted for diabetes and hypertension, the association of Group 1 and CKD was still significant (OR 2.09, 95% CI 1.26, 3.45, P = 0.004). Group 2 was associated with CKD (OR 1.81, 95% CI 1.29, 2.53, P = 0.001), when compared with Group 3. Further adjustment for factors which were potential confounders, Group 2 was still significantly associated with CKD. The OR for CKD was 1.75 (95% CI 1.22, 2.51, P = 0.002). When adjusted for diabetes and hypertension, the association between Group 2 and CKD still existed. The OR for CKD was 1.48 (95% CI 1.01, 2.16, P = 0.046). CONCLUSION: Our results showed that HW phenotype was associated with CKD in the population aged 40 years and older.